The Camden Coalition has been able to measure its long-term effect on its first thirty-six super-utilizers. They averaged sixty-two hospital and E.R. visits per month before joining the program and thirty-seven visits after—a forty-per-cent reduction. Their hospital bills averaged $1.2 million per month before and just over half a million after—a fifty-six-per-cent reduction.What are the keys to reducing costs in healthcare? Focus on the small population of uninsured who have many chronic medical conditions, and who frequent the hospital the most. One study showed that "frequent users comprise 4.5-8% of all ED patients but account for 21 to 28% of all visits." These are the patients where a relatively small amount of free but focused preventative care can result in a dramatic reduction in medical complications and healthcare costs.
I call this idea "healthcare's version of cash for clunkers" not to deride patients, but to emphasize where our efforts need to be most focused. When the US government wanted to reduce auto emissions, they realized that removing a single inefficient polluting old car from the roads had the same impact as trying to make marginal efficiency improvements in 10 newer cars. The conclusion was clear: it's efficient and logical to spend your money where you will have the most impact. The same applies in healthcare. Managing the chronic conditions of our poorest and sickest patients with focused caring preventative care costs much less managing the complications of those conditions.